POS0958 PROGRESSIVE IMPROVEMENT IN TIME TO DIAGNOSIS IN AXIAL SPONDYLOARTHRITIS THROUGH AN INTEGRATED REFERRAL AND EDUCATION SYSTEM
Authors: A. Chan, K. Rigler, N. Ahmad, T. Lafont
Journal: Annals of the Rheumatic Diseases (2022)

Background Despite the advances in the treatment and management of axial spondyloarthritis (axSpA), there remains a significant delay in the diagnosis of the condition. The diagnostic delay is 8-10 years in Europe and 8.5 years on average in the United Kingdom. This is contributed by the lack of awareness of axSpA, limited access to diagnostic tests and unstructured referral pathways. The delayed diagnosis leads to higher morbidity from the condition. Objectives To assess the delay in the diagnosis of axSpA over time in a real world axSpA cohort diagnosed over a 7 year period from 2015 and to evaluate factors associated with this delay. During this time, we evaluated the effectiveness of the interventions to reduce the delay to diagnosis. Methods A cohort of axSpA patients newly diagnosed between 2015 to 2021, were studied. This was a cross-sectional study on patients with axSpA who visited a specialist rheumatology clinic at a single centre. The demographic, clinical and diagnostic variables were recorded. Diagnostic delay was defined as the time interval between the year of first symptom and year of diagnosis. The mean and median diagnostic delay were calculated. An integrated educational and referral system were implemented from 2015 1 . This included education to the main referrers in to the system including general practitioners (GPs) and community musculoskeletal (MSK) triage physiotherapists. The electronic referral systems were updated annually according to best practice guidelines 2 . An impact analysis was performed evaluating diagnostic delay for axSpA during this period. Results Of the 110 axSpA patients studied, 60 (54.4%) were male and 50 (45.5%) female. The mean (range) age was 37 (18-52) years. All patients met the ASAS classification criteria for axSpA. Radiographic axSpA (Ankylosing spondylitis) fulfilling New York criteria, was diagnosed in (62%) of the patients. There were more patients with radiographic axSpA in the earlier years of diagnosis (100% in 2015) and more of non-radiographic axSpA in the later years (83% in 2021). HLA-B*27 positivity was found in 79 (71.8%) of patients. The majority of referrals were from general practitioners 63 (57.2%), physiotherapists 19 (17.3%), orthopaedics 18 (16.4%) and other specialties 10 (9.1%). There was no significant difference in the mean (years) delay to diagnosis from the source of the clinic referral. The mean and median delay to diagnosis by year of diagnosis were 9.9, 9.5 (±3.1) years in 2015, 7.1, 7(±1) in 2016, 5.3,5 (±2.7) in 2017, 4.9, 4 (±3) in 2018, 4.4, 2.5 (±4.8) in 2019, 3.6, 2 (±3.2) in 2020, 2.2, 1 (±2.6) in 2021. The majority of the patients were diagnosed between 31-40 years (41%), 22% between 18-30 years, 31% between 41-50 years and 4% after the age of 50 years. Higher age at diagnosis was associated with a longer diagnostic delay. Diagnosis of disease at 18-30 years of age was associated with shorter mean delay to diagnosis (2.9 years), age 31-40 (4.6), age 41-50 (5.9), and age &gt; 51 (6.5). Conclusion Delay in axSpA diagnosis has significantly improved in this real-world cohort during the last seven years. The mean diagnostic delay was 2 years indicating diagnostic delay may be for most patients shorter than previously reported. The factors associated with a faster diagnosis were a) more recent year of first rheumatology consult b) earlier age at presentation. Increased educational and awareness campaigns in primary care and musculoskeletal triage has led to the early recognition of axSpA. Early referral to a rheumatology service using electronic referral symptom can improve the diagnostic delay of axSpA. With continuous improvement cycles, our aim is to get reduce delays to diagnosis to under 1 year with line with the Gold Standard to Diagnosis in axSpA. References [1]All Party Parliamentary Group (APPG) on Axial Spondyloarthritis. 2019. [2] https://nass.co.uk/wp-content/uploads/2020/03/APPG-on-Axial-SpA-Second-Meeting-Minutes.pdf [3]NICE Guideline NG65. Spondyloarthritis in over 16s: diagnosis and management. 2017. https://www.nice.org.uk/guidance/ng65 Disclosure of Interests Antoni Chan Speakers bureau: Janssen, Novartis, Amgen, Abbvie, Celgene, UCB, Consultant of: Novartis, Lilly, Abbvie, Grant/research support from: Novartis, UCB, Kathryn Rigler: None declared, Nadia Ahmad: None declared, Tanguy Lafont: None declared